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Unit 2 - integrating principles of pharmacology

Terms in this set (53)

Drug Selection Criteria (9)
1. Cost
2. Guidelines
3. Availability
4. Interactions
5. Side Effects:Risk
6. Allergies
7. Dose (considering hepatic & renal function)
8. Monitoring requirements
9. Special populations
Why is cost important when prescribing medication as it applies to outcomes?
Cost affects compliance. The higher the cost, the less likely a patient is to take medication as prescribed.
Why are guidelines important when selecting a medication to prescribe?
Groups such as the American Heart Association release guidelines based on current research and expert practice. Many organizations have guidelines for their respective focus areas (AHA, ACA, IDSA, ADA).
Why is the patient's hepatic function important when selecting a medication?
Hepatic function affects the way many drugs are metabolized and eliminated from the body. Lower doses of drugs cleared by the liver may be needed for someone with liver dysfunction/damage. Other drugs may harm the liver and should also be considered when the liver is already damaged or at risk.
Why is the patient's renal function important when selecting a medication?
Renal function affects the way many drugs are metabolized and eliminated from the body. Lower doses of drugs cleared by the kidneys may be needed for someone with kidney dysfunction/damage. Other drugs may harm the kidneys, and should also be considered when the kidneys are already damaged or at risk.
What types of monitoring requirements may exist when selecting a medication to prescribe?
Blood levels, particularly with narrow range medications (lithium). Blood pressure effects. PT/INR for blood thinners (warfarin). Blood glucose (at home) and HgA1C (lab)
Minimum requirements for writing prescriptions
1. Prescriber info (Name, license #, contact info, DEA#)
2. Patient info (Name, DOB, Allergies)
3. Medication info (Name, indication, strength, dose, frequency, # tabs/capsules, #refills)
What prescriber information is required for prescriptions?
1. Name
2. License #
3. Contact info
4. DEA #
What patient information is required for prescriptions?
1. Name
2. DOB
3. Allergies
What medication information is required for prescriptions?
1. Name
2. indication
3. Strength (mg, mcg, etc)
4. Dose (how many ml, tab, etc)
5. Frequency (how often or when)
6. Number of total tabs/capsules/ml's
7. Number of refills (contingent on laws, monitoring frequency, etc)
What medias are used to "write" a prescription?
1. Telephone order (Schedule II for emergencies only and a written must be submitted within 7 days)
2. Written (avoid abbreviations, must be legible, not PRE-signed)
3. E-script (encouraged by CMS, "meaningful use", 2-factor authentication meets Schedule II needs)
What should a prescriber consider when writing refills?
Is the medication new or dose changed and require followup evaluation for effectiveness, side effects, etc.?
What are the current effects?
When was the patient's last visit?
Is it a Schedule II medication (no refills)?
Point-of-care prescription assistance websites
epocrates.com
online.lexi.com/action/home
Pepid.com
PDR.net
uptodate.com/contents/search
Point-of-care prescription assistance apps
CDC antibiotic guidelines
Elsevier Clinical Pharmacology
Epocrates
Pepid
Prescribers Letter
Who should a prescriber consider collaborating with when choosing medication regimens? (2)
Pharmacists
Infectious disease specialists
What are the cornerstones of the WHO Rational Use?
Appropriateness
Individualized dosing
Adequate length of therapy
Cost
What periodic labs are recommended for ACE Inhibitors and ARBs?
K+ (risk for HYPERkalemia)
Serum Creatinine (renal perfusion may be affected/dependent on angiotensin)
What periodic labs are recommended for amiodarone?
Liver function (hepatotoxic)
Thyroid function (HYPER/HYPOthyroid)
Pulmonary function (toxicity not uncommon but permanent)
Chest X-ray (toxicity not uncommon but permanent)
What periodic labs are recommended for anticonvulsants?
Serum drug levels (therapeutic dose index may be narrow)
What periodic labs are recommended for anti diabetics?
Serum glucose
HgA1c
What periodic labs are recommended for digoxin?
Digoxin level (narrow range therapeutic dose)
Serum electrolytes (HYPOkalemia, HYPOmagnesia, HYPOcalcemia can increase toxicity risk)
What periodic labs are recommended for K+ sparing diuretics?
Serum electrolytes (HYPERkalemia, HYPOcalcemia, HYPOmagnesia)
What periodic labs are recommended for loop diuretics & thiazides?
Serum electrolytes (HYPERkalemia, HYPOalcemia, HYPOmagnesia)
What periodic labs are recommended for lithium?
CBC (leukocytosis)
Lithium levels (narrow therapeutic range index)
Thyroid levels (HYPER/HYPOthyroid)
Renal panel (risk for renal damage)
Serum electrolytes (nephrogenic diabetes insidious can cause HYPOnatremia, affects therapy levels & creates complications)
What periodic labs are recommended for methotrexate?
CBC (pancytopenia)
Liver function (Hepatotoxic)
Renal function (Renal toxic)
What periodic labs are recommended for long-term NSAIDs?
CBC (anemia)
Serum creatinine (prostaglandin inhibition may decrease renal perfusion)
Liver function (rare but serious liver injury)
What periodic labs are recommended for statins?
Liver function (may cause liver injury)
Creatinine Kinase (muscle injury)
Lipid panel (effectiveness of therapy)
What periodic labs are recommended for thiazolidinediones?
Liver function (hepatotoxic)
What periodic labs are recommended for thyroid hormones?
TSH & T4 (monitor effectiveness)
What periodic labs are recommended for warfarin?
PT/INR (narrow therapeutic range)
Drugs with narrow therapeutic range (NTI)
Carbamazepine
Digoxin
Lithium
Phenytoin
Theophylline
Warfarin
Top reasons patients do NOT adhere to drug regimen
57% missed a dose
30% forgot to take a dose
28% did not fill meds on time
22% take lower dose than prescribed
20% did not refill
14% stopped taking medication altogether
Top reasons WHY patients do not adhere to drug regimen
42% forget
34% ran out
27% away from home
22% to save money
21% unpleasant side effects
17% too busy
17% saw no benefit
16% saw no value/necessity
12% didnt like taking it
How can a provider address issue of forgetting to take medication on time?
Integrate medications into established routine.
Utilize memory tools (organizers).
Technology (apps, reminders, alarms)
How can a provider address issue of poor planning when taking medications as prescribed?
Sign up for pharmacy reminders.
Place medications on Auto-refill.
Utilize home delivery services.
How can a provider address issue of cost regarding patient medication adherence?
Look for generic forms.
Investigate substitutions within the same family.
Utilize patient assistance programs.
How can a provider address issue of dissatisfaction regarding patient medication adherence?
Uncover underlying reason for dissatisfaction.
Provide education at every visit.
How can a provider address the issue of altered dosing regarding patient medication adherence (patient taking more/less than prescribed)?
Education - medications must be within therapeutic range or there is not point in taking the medication at all.
Medication management considerations
is it effective?
is it still necessary?
What problems have been created?
are there issues with polypharmacy?
What percent of prescribed medications are not taken correctly?
40%
Medicare Medication Therapy Management programs
FREE for those with multiple covered chronic illnesses or opioids with Medicare Part D Prescription coverage. GOAL = improve outcomes, lower costs, lower adverse events
1. Comprehensive review of medications and why each are prescribed.
2. Written summary with MD or pharmacist
3. Action plan

Pharmacists discuss:
1. Side effects
2. interactions
3. if/how costs can be lowered
4. safe disposal of unused medications
What is a Lead Agent?
A lead agent is the prototype, or the "original" drug that defines a group, family.

For example, propranolol is the lead agent for nonselective beta blockers.
What part of the drug name indicates the family of drugs?
Suffix
Drugs within the same family have similar ...
Therapeutic Effects
Allergies
If a patient experiences an allergic reaction to a drug ...
Choose a drug with a similar therapeutic effect, but from a DIFFERENT family
Allowing full prescriptive authority to APRNs ...
increases access to healthcare
"Independent" prescriptive authority for APRNs means that ...
No regulatory body limits APRNs prescriptive authority.
Why is it important to get a complete medical history prior to adding a new medication?
To evaluate interactions.
Schedule II drugs are
Not eligible for refill
If side effects are reported, what should the prescriber do next?
Perform a physical exam to determine ALL effects prior to making changes.
How does naloxone work?
acts by blocking the action of opioids at opioid receptors (antagonist)
Why must certain drugs be given IM vs. orally?
Some drugs, like Penicillin G, are destroyed by stomach acid.
Why is targeted therapy preferred over systemic therapy?
To reduce side effects and increase dose/effectiveness.
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